Massachusetts 2023-2024 Regular Session

Massachusetts House Bill H1087

Introduced
2/16/23  
Refer
2/16/23  

Caption

Preventing inappropriate denials by insurers for medically necessary services

Impact

The implementation of HB 1087 could significantly reform the claims process between health care providers and insurers. It prohibits the denial of claims solely on the basis of administrative or technical issues, unless the insurer has credible evidence of fraud. Furthermore, the bill sets strict timelines for recouping previous payments, which could protect providers and patients from unexpected charges and enhance the overall transparency of insurance claim practices. By doing so, it aims to foster a more supportive environment for both patients and medical providers navigating health care services.

Summary

House Bill 1087, introduced by Representative Kate Lipper-Garabedian, seeks to protect patients from inappropriate denials by health insurance carriers for medically necessary services. The bill establishes that health insurance providers are mandated to pay for services ordered by the treating healthcare provider if they qualify as covered benefits under the insured’s health plan and the services align with the carrier's clinical criteria. This measure aims to enhance patient access to necessary care and reduce administrative hurdles that often lead to delays or denials of important health services.

Contention

Discussion surrounding HB 1087 highlights potential contention points, particularly regarding the balance of authority between insurers and healthcare providers. Advocates for this bill argue that it addresses long-standing issues of unfair insurance practices that delay patient care. However, some insurance advocates express concerns that these provisions may hinder the ability of insurers to effectively manage risks and costs. They argue that the bill could lead to an increase in claims with less scrutiny, resulting in higher healthcare costs overall. Thus, while the bill aims to enhance patient rights, it raises questions about maintaining cost-effectiveness in health care provision.

Companion Bills

MA S663

Similar To To prevent inappropriate denials by insurers for medically necessary services

MA H4879

Replaced by Study Order

Previously Filed As

MA H3865

Relative to reimbursing armed service members

MA H3863

Relative to COLA adjustments for veteran benefits

MA H3864

Relative to public employee benefits for military service members on active duty

MA H1633

Relative to pre-trial detention

MA H89

Providing for consumer protection in a digital economy

MA H3521

Relative to COLA adjustments for veteran benefits

MA H1637

Bringing the crime of leaving the scene of personal injury causing death within the jurisdiction of the district court

MA H1846

Bringing the crime of leaving the scene of personal injury causing death within the jurisdiction of the district court

Similar Bills

No similar bills found.